Thursday 29 May 2014

Dale Weise's concussion raises serious questions about the Canadiens medical staff and its procedures.

So the mystery deepens.  After the hit on Dale Weise by John Moore Tuesday night, the Canadiens forward was visibly unwell, and was taken out of the game, yet he returned to action later in the game, to mostly everyone's puzzlement.  Fast forward to today, and he is described as suffering from a "body injury" by his head coach, and will not play tonight.

It doesn't add up.  He was obviously concussed after the hit, but was 'cleared' and went back to the bench, but now he's no longer cleared.  Michel Therrien followed accepted practice during his press conference, refusing to pinpoint the injury Dale was suffering from, but all his circumlocution couldn't resolve the confusion, allay the doubts.

The only explanation I can come up with for Weezy being allowed back on the ice after his apparent concussion last game is a breakdown in communication coupled with a lack of training/awareness by the coaching staff.

That Dale was staggered was obvious to any observer on Tuesday, P.K. had to 'rescue' him and help keep him upright.  I thought that any time someone is dazed or stunned by a blow to the head, or is knocked out even briefly, it is an indication of a concussion.  Beyond that, someone can still experience a concussion without getting his bell rung.

So I thought the quiet room and concussion protocol are for the latter case, to give a player who received a blow to the head but didn't seem affected initially a chance to catch his breath, consult with team doctors, and have a chance to diagnose a minor concussion away from the heat of the game.  The doctors would ask the player questions, established 'baseline' questions, as well as general "What day is it?  What month are we in?  Where are we?  What team are we playing?  What did you have for lunch?" questions.  If he answered all these questions adequately, and didn't report any pain or symptoms, then he would be allowed back in the game, but only if he hadn't gotten dazed or knocked out.

When the player has been dazed, these questions are only to diagnose the severity, the degree of injury.  That's what I believe(d) is the case, that for him there isn't any doubt about whether there is a concussion, just how bad it is, and how long might the player have to sit out.  The questions and the quiet room protocol are only to help the doctors diagnose the extent of the concussion, the treatment required, the prognosis.  That the player would certainly not be put back in the game in these cases, no matter how much they claimed to be okay and begged to go back in.

So working off these assumptions, and setting aside the possibility that the medical team is incompetent or negligent, the only way I can excuse/explain letting Dale back on the ice is that the medical team didn't see him be all wobbly-legged on the ice, and they weren't told this by the players or the coaches.  So they took Dale back in the tunnel, he seemed fine and had his balance back by then, they went through the steps, and they cleared him as the protocols state.

While this seems unlikely, it happened a couple years ago in an NFL game when Chargers offensive guard Kris Dielman was knocked out on his feet, and wobbled and almost fell between snaps.  Referees approached him to ask what was wrong, he waved them off and assured them he was okay.  He gutted out the rest of the game, being the All Pro warrior that he was, knowing that there were already a few offensive linemen who had been felled by injuries during the game.  He figured he was the last man standing, and could play, whereas the others had 'real' injuries to their legs and arms, they couldn't block.  He managed to finish the game, but later suffered a seizure on the flight home, and this was a severe enough episode that he never played another game and retired.

There was a lot of finger pointing and soul searching, and it was found that the reason Mr. Dielman was allowed to continue to play, that no medical staff came to his aid and attended to him, was that they were all busy dealing with the other injured players on the sidelines, no one was watching the field.

Two changes came about because of this incident.  NFL teams now have to have at least one medical staff member observing the field of play at all times, they can't all get sucked in taping one guy's ankle or dealing with the QB's sore finger.

Further, the referees during the game now have the authority to stop play and signal for help from the medical staff when they observe a player in distress.  While they themselves don't have medical training and can't diagnose anything, they can use common sense, and make use of this provision when it's reasonable, like it would have been in the Kris Dielman case.  It's another layer of protection, and allows for more eyes and ears on the field to safeguard players who are potentially injured.

So on Tuesday, there was one big error, in that the medical staff didn't observe Dale staggering around and weren't told about this, and the other error came when the coaches allowed him back on the bench.  They should have a basic understanding of the concussion protocol, and they must have seen him on the ice.  They should have known right then that his night was over, that he wouldn't return to action.  When Dale came back to the bench, under whatever authority, the coach(es) should have said to that person: "Hold on a second, Dale could barely stand up after the hit, he can't be cleared to return to action, right?..."

For Michel Therrien to state in the press conference that player safety is primordial, but in the same breath say that Dale was okay and there was no concussion and that he was cleared, is contradictory.  If player safety is the most important consideration, then he should have the basic understanding of this critical aspect of the equation, he should have gotten clarification from his training/medical staff when they let Dale back on the bench, and probably over-ruled them, if they hadn't seen Dale immediately after the hit.

That's the best spin I can put on this cluster, that the Canadiens/NHL teams need to have better communication between their players and coaches and their medical staff after these kinds of incidents, and that the coaches need to have a better grasp of the fundamentals of concussion symptoms and treatment.  If that isn't the case, then we need to revisit the incompetence-negligence angle.

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